Emphysema

By staff

US Pharm. 2018:43(7):13-14.

A Form of COPD

Emphysema is a type of chronic obstructive pulmonary disease (COPD), which is the third leading cause of death in the United States behind heart disease and cancer. Emphysema is caused by damage to the air sacs of the lungs (alveoli) after long-term exposure to airborne irritants. Over time, the damaged alveoli weaken and rupture, creating a smaller lung surface area and, consequently, causing less oxygen to reach the bloodstream. Emphysema is a chronic condition that develops slowly and worsens over time. People with emphysema have significant trouble breathing, which can impact their work, ability to exercise, quality of sleep, and other daily activities.

Smoking Is the Leading Cause

The primary risk factor for emphysema is smoking, although extended exposure to air pollution or chemical fumes, as well as a rare genetic deficiency, can also lead to disease. About 85% of all people with emphysema are current smokers or have smoked in the past. The risk of developing emphysema increases with the number of years of smoking and the amount of tobacco smoked. While cigarette smokers are at highest risk, pipe and cigar smokers also have an elevated risk of disease. People who do not smoke but who live with a smoker are also at risk because of exposure to secondhand smoke.

The symptoms of emphysema occur gradually and often go unnoticed for many years. Because of the damage to the lung tissue, persons with developing emphysema require more effort to breathe and, as a result, tire sooner. This leads to shortness of breath with even minor exertion. People with emphysema also experience such symptoms as chronic cough, chest tightness, and wheezing. For long-term smokers, symptoms usually become noticeable between ages 45 and 60 years.

Combined with a thorough medical history and assessment of symptoms, physicians use a series of pulmonary function tests (PFTs) to assist in the diagnosis of emphysema. PFTs measure lung size, airflow, the transfer of gases (like oxygen) into and out of the blood, and inflammation. Also, chest x-rays, CT scans, blood tests, and lung biopsies may be performed to rule out other causes of lung dysfunction, such as lung cancer.

Treatment Manages Symptoms

There is no cure to reverse the damage to the lung tissue that leads to emphysema. The primary goal of treatment is to slow the progression, relieve the symptoms, and prevent complications of the disease. The most critical intervention for the treatment of emphysema is smoking cessation. Evidence shows that quitting significantly improves lung function. Patients with emphysema who quit smoking can reduce their decline in lung function to match the function of others of the same age, weight, and sex who are nonsmokers.

Medications are used to improve the symptoms of emphysema and to treat complications such as infections. Bronchodilators are inhalers that can relieve shortness of breath and breathing problems by opening the constricted airways. Inhaled corticosteroids are sometimes given to reduce inflammation and improve shortness of breath. Antibiotics are given if the patient experiences a bacterial infection, such as pneumonia or acute bronchitis.

Other treatments include instruction in effective breathing exercises, oxygen therapy, and nutrition therapy. In more severe cases, surgical options include removal of the damaged lung tissue to allow the remaining healthy tissue to expand and lung transplantation.

Complications and Prognosis

The prognosis for those with emphysema depends on the severity of the disease, the symptoms, and the presence of complications. Having emphysema can lead to complications of the lung and the heart. High blood pressure, enlargement of the heart, and potentially heart failure can result from the constant strain on the heart caused by reduced oxygen. People with COPD are also at increased risk for respiratory infections during cold and flu season. Lastly, difficulties in adjusting to changes in health and lifestyle can lead to clinical depression.

If you have any questions about treatments for emphysema, speak with your trusted local pharmacist or another healthcare provider.